Shavonda Wells can’t wait to have this baby.
It’s hard to keep up with her four little ones while pregnant with No. 5, she tells her nurse midwife, Alexandra Bratschie, CNM, WHNP. She has not had contractions, just discomfort caused by pressure from the baby’s head.
“I feel at this point, he’s going to be overdue,” she says, her hand on her belly, her eyes worried.
Wells is at her 38-week prenatal visit at Spectrum Health Obstetrics-Gynecology Residency Practice. Bratschie reminds her she is closing in on her due date. At next week’s visit, they can set up a plan for labor. They may be able to take steps to soften the cervix or schedule an induction.
“I promise you: You will go into labor,” she says. “That will happen.”
Two of Wells’ daughters have accompanied her for the prenatal visit―Alaina Lindsey, 8, and Amina Smith, 7. They talk excitedly about welcoming a little brother.
They know his name, “but we can’t say it,” announces Amina. “His nickname is Little Foot, so that’s what we call him.”
The best thing ever is going through 40 weeks with a woman as she goes through pregnancy, labor and the birth process.
Bratschie asks the girls to help her listen to the baby’s heart. She hands Alaina the Doppler wand and guides it across her mother’s belly. To Amina, she gives the monitor that displays the heart rate.
After a moment, a loud whirring, rhythmic sound emerges. The girls look up, startled.
“That’s the baby’s heartbeat,” Bratschie says.
The girls grin. Amina holds the monitor to her mouth, like a walkie-talkie. If she can hear the baby’s heart, she figures he can hear her.
“It’s OK, little brother,” she says as the grownups erupt with laughter. “I love you!”
Kids, heartbeats, babies, moms―they are all part of the fabric of the day-to-day life of a nurse midwife at Spectrum Health.
“The best thing ever is going through 40 weeks with a woman as she goes through pregnancy, labor and the birth process,” Bratschie says. “It is such a joy.”
A nurse midwife’s relationship with a woman begins well before the baby arrives and continues afterward.
“We are trained to look at birth and women’s health as a holistic practice, where everything is connected―the mind, body and medical aspects,” Bratschie says. “Our training is very women-centered. We really focus on educating women and their families so they can make their own informed decisions.”
And in the OB-GYN residency clinic, the nurse midwives have other duties, too. They train OB-GYN residents, sharing their specialized knowledge of obstetrical care, labor and delivery with the new physicians.
“We are part of the core faculty―a group of physicians and midwives working at the hospital 24/7 and teaching OB-GYN residents,” says Allison Tran, CNM, a nurse midwife who works in labor and delivery. “We care for the low-risk patients, and the attending physicians care for the high-risk patients.
Tran addresses a common misconception about midwife deliveries: They don’t require “an all-natural” childbirth.
“My philosophy is whatever a woman wants,” she says. “If a woman comes in and she wants an epidural, she gets an epidural. If she doesn’t want one and she needs labor support, then we help her with that, too.”
On this day, Bratschie is in the clinic, seeing women who have come for their prenatal appointments. Accompanying her is Mary Starrs, a second-year medical student at the Michigan State University College of Human Medicine.
‘They grow up too fast’
Jocelyn Wielhauwer, 30 weeks pregnant with her second child, lies back on the exam table as Bratschie measures her belly and listens to the baby’s heartbeat.
“Everyone at work says, ‘You’re about to pop,’” she says. “I tell them, ‘No, I still have nine weeks to go.’”
Bratschie talks about the signs of premature labor, such as cramping, back pain and contractions.
“If it comes and goes, that’s normal,” she says. “But if it lasts, call the clinic.”
Wielhauwer, who doesn’t have paid maternity leave, asks when she can go back to work after the baby is born.
“We usually give six weeks after a vaginal delivery to recover,” Bratschie says. “Also, it gives you time to bond with the baby. That’s time you don’t get back.”
“Yes,” Wielhauwer agrees. “They grow up too fast.”
Throughout the day, Bratschie provides timely advice to her prenatal patients. With those late in pregnancy, she talks about the signs of high blood pressure, such as blurred vision, bad headaches and pain under the right ribs.
When she sees patients after the baby is born, she discusses their health postpartum and provides contraceptive counseling. “I try to provide some sort of education each time,” she says.
Bratschie’s training includes eight years of education: four years of undergraduate studies as a pre-medical student, two years of nursing school and another two years of training to be certified as a nurse midwife and nurse practitioner in women’s health. She also has worked as a doula.
The nurse midwives’ philosophy of care puts an emphasis on allowing the body to go into labor on its own, she says.
“We kind of call ourselves watchful waiters,” she says. “We monitor the physical and emotional aspects and if we need to intervene medically, we intervene.”
Awaiting ‘Mama’s princess’
On an early March morning, Brandy Harris grips the rails of her bed and shakes them, groaning as a contraction builds in intensity. She is in the Family Birthplace at Spectrum Health Butterworth Hospital, in labor with her fourth child. She is determined to deliver her baby without an epidural.
Tran tends to her needs, along with Andrea Smith, RN, a labor and delivery nurse, and Megan LaBine, MD, an OB-GYN resident physician.
Between contractions, Harris says she went into labor at about 4 a.m. that morning, two days before her due date. She stayed home for the first hour of labor, keeping busy by washing walls, vacuuming and other housecleaning chores.
Her hair hangs in long black and silver braids, dramatically framing her face. She had it styled recently, in anticipation of delivery day.
There might be an acupressure effect from a hair appointment that helps stimulate labor hormones, Tran says. The evidence is anecdotal, but some people believe getting their hair styled or having a pedicure can lead to labor.
That makes sense to Harris.
“I never go into labor without getting my hair done,” she says.
Now the contractions are two to three minutes apart. But an examination shows her baby is floating freely in the womb.
“Our plan is to get her lower and break your water when we can,” Tran says.
The contractions slow, occurring further apart. The medical team requests an ultrasound scan to check the baby’s position.
Smith watches as the image appears on the screen.
“Yep, we’ve got a head down there,” she says.
Harris asks for apple juice and drinks it gratefully. She talks about her children at home―Isaiah, 7, Mikhail, 2, and Jonathan, 18 months.
By 1 p.m., the labor pains are growing stronger and more frequent. Exhausted, Harris sleeps during the brief moments between contractions.
“I’m worried I won’t have the strength to push when the time comes,” she says.
In a moment of rest, her water breaks. Things move quickly then.
Harris groans in pain. The women surround her saying, “Brandy, you’ve got this. You are doing so good. You are phenomenal.”
Two strong pushes and little Alexis Harris slides into the world, a screaming 7 pound, 1 ounce baby girl. As her mom lies back shaking from the effort, she asks Alexis’ dad, Michael Barker, to cut the umbilical cord.
Harris holds Alexis against her chest and greets her with a steady stream of sweet words.
“You’re so beautiful, Alexis,” she says. “Mama loves you so much. I waited for you―Mama’s princess.”
She strokes her daughter’s tiny hands. Alexis’ right arm is shorter and the hand has just three fingers. An ultrasound during pregnancy had revealed this, so Harris is not surprised.
“You are so pretty,” she says. “Mama loves you so much.”
Eventually, the nurses will measure and weigh Alexis. The neonatal intensive care unit team will take a closer look at her arm.
But for now, Alexis will enjoy an hour cuddling with her mother and nursing for the first time.
Tran has brought more than 500 babies into the world in her nine years as a nurse midwife.
Each mother labors and delivers in her own way. She may sit on a birthing ball, stand or lie in a bed during contractions. Some give birth in the bed, while others deliver standing up, holding on to a “squat bar.”
Some have epidurals. Some do not. Some opt to give birth in a natural birthing suite, rooms in the Family Birthplace for those who want to deliver in a home-like environment.
“We support whatever they want,” Tran says. “It’s really about empowerment.”
A happy delivery
Rachel Underwood holds her daughter Mae in her arms, cradling the 6-week-old infant with practiced arms, as she talks about her family.
She delivered her first daughter, Annabelle, four years ago. The delivery involved a day of labor, followed by an emergency cesarean section. A couple of years later, she and her husband, Jordan, adopted their second daughter, Norah, now 18 months old.
When she became pregnant with Mae, Underwood set out to find a nurse midwife.
“I knew I wanted to have a VBAC (vaginal birth after C-section), and I thought the best chance of that was to go to a midwife,” she says.
Vaginal births after a C-section carry a small risk of uterine rupture. However, 60 to 80% of those who attempt labor are able to have a vaginal birth, according to the American College of Obstetricians and Gynecologists.
At the residency clinic, she saw Bratschie and other nurse midwives for prenatal appointments. She appreciates the education she received with each visit and the practical tips―for dealing with pelvic pain and better sleep, for example.
“(Bratschie) would come in with recommendations on what to do next or what to expect without me ever having to ask,” Underwood says. “I knew I was going to get the answers that I didn’t even know I needed.”
During labor and delivery, she received care from both a nurse midwife and an obstetrician. Mae arrived―without need of a C-section―as a healthy 9 pound, 9 ounce baby.
Underwood says she was thrilled with her nurse midwife experience. Throughout her pregnancy and delivery, she appreciated the nurse midwives’ philosophy of care.
“They were very, very vocal about the fact that this was going to go my way,” she said. “They were going to do everything within their power to make that happen―without putting me or the baby at risk, obviously.”